Luo Qingwei, O'Connell Dianne L, Kahn Clare, Yu Xue Qin
Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
Cancer Epidemiol. 2017 Aug;49:92-100. doi: 10.1016/j.canep.2017.05.012. Epub 2017 Jun 6.
No previous Australian population-based studies have described or quantified the progression of colorectal cancer (CRC) to metastatic disease. We describe patterns of progression to metastatic disease for an Australian cohort diagnosed with localised or regional CRC.
All localised and regional CRC cases in the New South Wales Cancer Registry diagnosed during 2000-2007 were followed to December 2011 for subsequent metastases (identified by subsequent disease episode notifications) or CRC death. Cox regression was used to identify factors associated with metastatic progression.
After a median 5.3 years follow-up, 26.4% of the 12757 cases initially diagnosed with localised or regional colon cancer had developed metastatic disease, as had 29.5% of the 7154 rectal cancer cases. For both cancer sites, risk of metastatic progression was significantly higher for those initially diagnosed with regional disease (adjusted hazard ratio [aHR] 3.49 for colon, 2.66 for rectal cancer), and for older cases (e.g. aHR for >79years vs <60years: 1.38 for colon, 1.69 for rectal cancer). Risk of disease progression was significantly lower for females, and varied by histology type. For colon cancer, the risk of disease progression decreased over time. For rectal cancer, risk of metastatic progression was significantly higher for those living in more socioeconomically disadvantaged areas compared with those in the least disadvantaged area.
An understanding of the variation in risk of metastatic progression is useful for planning health service requirements, and can help inform decisions about treatment and follow-up for colorectal cancer patients.
此前尚无澳大利亚基于人群的研究描述或量化结直肠癌（CRC）进展为转移性疾病的情况。我们描述了澳大利亚一组被诊断为局限性或区域性CRC患者进展为转移性疾病的模式。
对新南威尔士癌症登记处2000年至2007年期间诊断的所有局限性和区域性CRC病例进行随访，直至2011年12月，以确定随后的转移情况（通过随后的疾病发作通知确定）或CRC死亡情况。使用Cox回归来确定与转移进展相关的因素。
经过中位5.3年的随访，最初被诊断为局限性或区域性结肠癌的12757例病例中有26.4%发生了转移性疾病，最初被诊断为直肠癌的7154例病例中有29.5%发生了转移性疾病。对于这两种癌症部位，最初被诊断为区域性疾病的患者发生转移进展的风险显著更高（结肠癌的调整风险比[aHR]为3.49，直肠癌为2.66），老年患者也是如此（例如，>79岁与<60岁相比的aHR：结肠癌为1.38，直肠癌为1.69）。女性疾病进展的风险显著较低，且因组织学类型而异。对于结肠癌，疾病进展的风险随时间降低。对于直肠癌，与最不贫困地区的患者相比，生活在社会经济条件较差地区的患者发生转移进展的风险显著更高。
了解转移进展风险的差异有助于规划卫生服务需求，并可为结直肠癌患者的治疗和随访决策提供参考。
